Provider Demographics
NPI:1699806927
Name:LIN, LOONG C (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:LOONG
Middle Name:C
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 & 1-2 N SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2426
Mailing Address - Country:US
Mailing Address - Phone:626-309-0011
Mailing Address - Fax:
Practice Address - Street 1:121 & 1 2 N SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2426
Practice Address - Country:US
Practice Address - Phone:626-309-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics